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STORMWATER ANNUAL REPORT -METAL MINING (& COAL) <br />Permit Cert. No. COR-04 <br />Second Inspection -Date _/ / .Findings, and action taken: <br />Other Inspections -Date _/_/_. Findings, and action taken: <br />C. Results and interpretation of any stormwater monitoring performed. Attach a separate sheet with the lab <br />results. (Monitoring is not a requirement under the permit, unless you were specifically directed to do so by the <br />Division. However, the results of any stormwater monitoring that you performed on your own should be reported <br />here.) <br />Monitoring Results Attached? ~ No ~ Yes <br />D. Certification <br />i <br />"I certify under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in. accordance with a system designed to assure that qualified personnel properly gather and evaluate the <br />information submitted. Based on my inquiry of the person or persons who manage the system, or those persons <br />directly responsible for gathering the information, the information submitted is, to the best of my knowledge and <br />belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, <br />including the possibility of fine and imprisonment for knowing violations." <br />Signature of Permittee (legally responsible person) Date Signed <br />Name (printed) <br />Title <br />Use additional pages as needed. Page 2 of 2 ertrsen <br />